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The integration of the history and geography of diseases is essential to understanding and revealing a true picture of epidemiology and disease patterns as they are today. This is particularly true for the current pandemic of the Acquired Immunodeficiency Syndrome (AIDS). The complexity and capabilities of the disease agent, the Human Immunodeficiency Virus Type 1 (HIV-I), generate increasing concern about this fatal disease. Thus far, treatment merely temporarily extends lives of the victims, and hope for a vaccine against infection remains remote. Understanding the mechanisms and patterns of the origin and diffusion of the infection and disease are central to developing appropriate intervention strategies for controlling its spread. In this paper an overview of AIDS is presented from the perspective of medical geography. Characteristics of the virus and the mechanisms of infection are described, and, using available evidence, an attempt is made to piece together the spatial-temporal patterns of the disease. Theories about the African origin and its diffusion there are discussed and pathways out of Africa to other parts of the world presented. Specific attention is directed to the spatial diffusion of AIDS within the United States. Cultural, social, behavioral, economic, political and transportation factors play important roles in the current and historical spatial patterns of AIDS. The historic importance of this disease and the complex of geographic factors necessary to its understanding require the interest and cooperation of a broad range of geographic specialties. We hope this paper informs and stimulates discussion among geographers to undertake this effort. [ABSTRACT FROM AUTHOR]

The article presents comments of the authors on the article "The Origin and Diffusion of AIDS: A View From Medical Geography," by G.W. Shannon and G.F. Pyle. Shannon and Pyle misrepresent evidence that exists in the literature about the first appearance in Africa of HIV and about the methods of transmission of AIDS on that continent. They also ignore evidence contained in articles they cite which runs counter to their thesis, as well as a readily available paper, written by a geographer, that suggests that the question of the spatial origins of AIDS is largely irrelevant. In addition to that, the article presents various other information.

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We present a geographical analysis of the first 22 months of the Department of Defense's human immunodeficiency virus (HIV) screening program for military applicants. This analysis concerns four HIV epidemic loci in the United States: New York City; Miami, Florida: Houston, Texas; and San Francisco, California. The cartographic analysis, using a novel smoothing algorithm to stabilize county-based rates, highlights the diffusion of the HIV epidemic from areas with relatively high prevalence to areas with relatively low prevalence of antibody to HIV. While there are particularities specific to each region, the diffusion patterns are remarkably consistent: areas closer to an endemic focus experience a slight decline over time, while more distant areas increase. The diffusion process depicted in map sequences demonstrates expansion diffusion in all four areas, while some provide a clear indication of a mixture of expansion and hierarchical processes. A previous analysis of these data for a fifteen-month period had concluded there was no evidence of a geographic trend in the data. Those conclusions were based on all ages pooled and used multi-state geographic units, making it unlikely that trends in prevalence, which varied by proximity to HIV epicenters, would have been detected. In view of the temporal crossover between the endemic and nonendemic areas' prevalence rates observed in Florida, Texas and California, any spatial analysis of these data using statewide summary rates will obscure the spatial-temporal trends. These data provide compelling evidence for the existence of sub-state level epidemics growing spatially and temporally into areas some miles from the original epicenters. We hope these results will encourage other public health personnel to undertake detailed surveillance of the AIDS and HIV infection epidemics at a unit of analysis small enough to permit quantifying spatial diffusion of this epidemic. [ABSTRACT FROM AUTHOR]

The article presents comments of the author on the article "The Origin and Diffusion of AIDS" by G.W. Shannon and G.F. Pyle. Shannon and Pyle have made a significant contribution to understanding of the diffusion pathways being followed by MDS. They dearly are well grounded in what currently is known about the nature of the disease, and their portrayal of how it is spreading in the U.S. is enlightening, as well as unsettling in its ramifications. When it comes to interpreting "The African Experience," however, they grasp at some rather far-fetched straws and in the process reveal a lack of understanding of the continent's cultural patterns. In addition to that, the article presents various other information.